become aroused. If we cannot do away with a delusion by taking reality
into account, it can hardly have arisen from reality. But the delusion,
what is its origin? There are delusions of the most widely varied
content. Why is it that in our case the content should be jealousy? In
what types of persons are obsessions liable to occur, and, in
particular, obsessions of jealousy? We would like to turn to the
psychiatrist with such questions, but here he leaves us in the lurch.
There is only one of our queries which he heeds. He will examine the
family history of this woman and _perhaps_ will give us the answer: "The
people who develop obsessions are those in whose families similar and
other psychic disturbances have repeatedly occurred." In other words, if
this lady develops an obsession she does so because she was predisposed
to it by reason of her heredity. That is certainly something, but is it
all that we want to know? Is it all that was effective in causing this
breakdown? Shall we be content to assume that it is immaterial,
accidental and inexplicable why the obsession of jealousy develops
rather than any other? And may we also accept this sentence about the
dominance of the influence of heredity in its negative meaning, that is,
that no matter what experiences came to this human being she was
predestined to develop some kind of obsession? You will want to know why
scientific psychiatry will give no further explanation. And I reply, "He
is a rascal who gives more than he owns." The psychiatrist does not know
of any path that leads him further in the explanation of such a case. He
must content himself with the diagnosis and a prognosis which, despite a
wealth of experience, is uncertain.
Yet, can psychoanalysis do more at this point? Indeed yes! I hope to
show you that even in so inaccessible a case as this it can discover
something which makes the further understanding possible. May I ask you
first to note the apparently insignificant fact that the patient
actually provoked the anonymous letter which now supports her delusion.
The day before, she announces to the intriguing chambermaid that if her
husband were to have an affair with a young girl it would be the worst
misfortune that could befall her. By so doing she really gave the maid
the idea of sending her the anonymous letter. The obsession thus attains
a certain independence from the letter; it existed in the patient
beforehand--perhaps as a dread; or was it a wish? Consider, moreover,
these additional details yielded by an analysis of only two hours. The
patient was indeed most helpful when, after telling her story, she was
urged to communicate her further thoughts, ideas and recollections. She
declared that nothing came to her mind, that she had already told
everything. After two hours the undertaking had really to be given up
because she announced that she already felt cured and was sure that the
morbid idea would not return. Of course, she said this because of this
resistance and her fear of continuing the analysis. In these two hours,
however, she had let fall certain remarks which made possible definite
interpretation, indeed made it incontestable; and this interpretation
throws a clear light on the origin of her obsession of jealousy. Namely,
she herself was very much infatuated with a certain young man, the very
same son-in-law upon whose urging she had come to consult me
professionally. She knew nothing of this infatuation, or at least only a
very little. Because of the existing relationship, it was very easy for
this infatuation to masquerade under the guise of harmless tenderness.
With all our further experience it is not difficult to feel our way
toward an understanding of the psychic life of this honest woman and
good mother. Such an infatuation, a monstrous, impossible thing, could
not be allowed to become conscious. But it continued to exist and
unconsciously exerted a heavy pressure. Something had to happen, some
sort of relief had to be found and the mechanism of displacement which
so constantly takes part in the origin of obsessional jealousy offered
the most immediate mitigation. If not only she, old woman that she was,
was in love with a young man but if also her old husband had an affair
with a young girl, then she would be freed from the voice of her
conscience which accused her of infidelity. The phantasy of her
husband's infidelity was thus like a cooling salve on her burning wound.
Of her own love she never became conscious, but the reflection of it,
which would bring her such advantages, now became compulsive,
obsessional and conscious. Naturally all arguments directed against the
obsession were of no avail since they were directed only to the
reflection, and not to the original force to which it owed its strength
and which, unimpeachable, lay buried in the unconscious.
Let us now piece together these fragments to see what a short and
impeded psychoanalysis can nevertheless contribute to the understanding
of this case. It is assumed of course that our inquiries were carefully
conducted, a point which I cannot at this place submit to your judgment.
In the first place, the obsession becomes no longer nonsensical nor
incomprehensible, it is full of meaning, well motivated and an integral
part of the patient's emotional experience. Secondly, it is a necessary
reaction toward an unconscious psychological process, revealed in other
ways, and it is to this very circumstance that it owes its obsessional
nature, that is, its resistance to arguments based on logic or fact. In
itself the obsession is something wished for, a kind of consolation.
Finally, the experiences underlying the condition are such as
unmistakably determine an obsession of jealousy and no other. You will
also recognize the part played by the two important analogies in the
analysis of the symptomatic act with reference to its meaning and intent
and also to its relation to an unconscious factor in the situation.
Naturally, we have not yet answered all the questions which may be put
on the basis of this case. Rather the case bristles with further
problems of a kind which we have not yet been able to solve in any way,
and of others which could not be solved because of the disadvantage of
the circumstances under which we were working. For example: why is this
happily married woman open to an infatuation for her son-in-law, and why
does the relief which could have been obtained in other ways come to her
by way of this mirror-image, this projection of her own condition upon
her husband? I trust you will not think that it is idle and wanton to
open such problems. Already we have much material at our disposal for
their possible solution. This woman is in that critical age when her
sexual needs undergo a sudden and unwelcome exaggeration. This might in
itself be sufficient. In addition, her good and faithful mate may for
many years have been lacking in that sufficient sexual capacity which
the well-preserved woman needs for her satisfaction. We have learned by
experience to know that those very men whose faithfulness is thus placed
beyond a doubt are most gentle in their treatment of their wives and
unusually forbearing toward their nervous complaints. Furthermore, the
fact that it was just the young husband of a daughter who became the
object of her abnormal infatuation is by no means insignificant. A
strong erotic attachment to the daughter, which in the last analysis
leads back to the mother's sexual constitution, will often find a way to
live on under such a disguise. May I perhaps remind you in this
connection that the relationship between mother and son-in-law has
seemed particularly delicate since all time and is one which among
primitive peoples gave rise to very powerful taboos and avoidances.[37]
It often transgresses our cultural standards positively as well as
negatively. I cannot tell you of course which of these three factors
were at work in our case; whether two of them only, or whether all of
them cooperated, for as you know I did not have the opportunity to
continue the analysis beyond two hours.
I realize at this point, ladies and gentlemen, that I have been speaking
entirely of things for which your understanding was not prepared. I did
this in order to carry through the comparison of psychiatry and
psychoanalysis. May I now ask one thing of you? Have you noticed any
contradiction between them? Psychiatry does not apply the technical
methods of psychoanalysis, and neglects to look for any significance in
the content of the obsession. Instead of first seeking out more specific
and immediate causes, psychiatry refers us to the very general and
remote source--heredity. But does this imply a contradiction, a conflict
between them? Do they not rather supplement one another? For does the
hereditary factor deny the significance of the experience, is it not
rather true that both operate together in the most effective way? You
must admit that there is nothing in the nature of psychiatric work which
must repudiate psychoanalytic research. Therefore, it is the
psychiatrists who oppose psychoanalysis, not psychiatry itself.
Psychoanalysis stands in about the same relation to psychiatry as does
histology to anatomy. The one studies the outer forms of organs, the
other the closer structure of tissues and cells. A contradiction between
two types of study, where one simplifies the other, is not easily
conceivable. You know that anatomy to-day forms the basis of scientific
medicine, but there was a time when the dissection of human corpses to
learn the inner structure of the body was as much frowned upon as the
practice of psychoanalysis, which seeks to ascertain the inner workings
of the human soul, seems proscribed to-day. And presumably a not too
distant time will bring us to the realization that a psychiatry which
aspires to scientific depth is not possible without a real knowledge of
the deeper unconscious processes in the psychic life.
Perhaps this much-attacked psychoanalysis has now found some friends
among you who are anxious to see it justify itself as well from another
aspect, namely, the therapeutic side. You know that the therapy of
psychiatry has hitherto not been able to influence obsessions. Can
psychoanalysis perhaps do so, thanks to its insight into the mechanism
of these symptoms? No, ladies and gentlemen, it cannot; for the present
at least it is just as powerless in the face of these maladies as every
other therapy. We can understand what it was that happened within the
patient, but we have no means of making the patient himself understand
this. In fact, I told you that I could not extend the analysis of the
obsession beyond the first steps. Would you therefore assert that
analysis is objectionable in such cases because it remains without
result? I think not. We have the right, indeed we have the duty to
pursue scientific research without regard to an immediate practical
effect. Some day, though we do not know when or where, every little
scrap of knowledge will have been translated into skill, even into
therapeutic skill. If psychoanalysis were as unsuccessful in all other
forms of nervous and psychological disease as it is in the case of the
obsession, it would nevertheless remain fully justified as an
irreplaceable method of scientific research. It is true that we would
then not be in a position to practice it, for the human subjects from
which we must learn, live and will in their own right; they must have
motives of their own in order to assist in the work, but they would deny
themselves to us. Therefore let me conclude this session by telling you
that there are comprehensive groups of nervous diseases concerning which
our better understanding has actually been translated into therapeutic
power; moreover, that in disturbances which are most difficult to reach
we can under certain conditions secure results which are second to none
in the field of internal therapeutics.
SEVENTEENTH LECTURE
GENERAL THEORY OF THE NEUROSES
_The Meaning of the Symptoms_
In the last lecture I explained to you that clinical psychiatry concerns
itself very little with the form under which the symptoms appear or with
the burden they carry, but that it is precisely here that psychoanalysis
steps in and shows that the symptom carries a meaning and is connected
with the experience of the patient. The meaning of neurotic symptoms was
first discovered by J. Breuer in the study and felicitous cure of a case
of hysteria which has since become famous (1880-82). It is true that P.
Janet independently reached the same result; literary priority must in
fact be accorded to the French scholar, since Breuer published his
observations more than a decade later (1893-95) during his period of
collaboration with me. On the whole it may be of small importance to us
who is responsible for this discovery, for you know that every discovery
is made more than once, that none is made all at once, and that success
is not meted out according to deserts. America is not named after
Columbus. Before Breuer and Janet, the great psychiatrist Leuret
expressed the opinion that even for the deliria of the insane, if we
only understood how to interpret them, a meaning could be found. I
confess that for a considerable period of time I was willing to estimate
very highly the credit due to P. Janet in the explanation of neurotic
symptoms, because he saw in them the expression of subconscious ideas
(_idees inconscientes_) with which the patients were obsessed. But since
then Janet has expressed himself most conservatively, as though he
wanted to confess that the term "subconscious" had been for him nothing
more than a mode of speech, a shift, "_une facon de parler_," by the use
of which he had nothing definite in mind. I now no longer understand
Janet's discussions, but I believe that he has needlessly deprived
himself of high credit.
The neurotic symptoms then have their meaning just like errors and the
dream, and like these they are related to the lives of the persons in
whom they appear. The importance of this insight into the nature of the
symptom can best be brought home to you by way of examples. That it is
borne out always and in all cases, I can only assert, not prove. He who
gathers his own experience will be convinced of it. For certain reasons,
however, I shall draw my instances not from hysteria, but from another
fundamentally related and very curious neurosis concerning which I wish
to say a few introductory words to you. This so-called compulsion
neurosis is not so popular as the widely known hysteria; it is, if I may
use the expression, not so noisily ostentatious, behaves more as a
private concern of the patient, renounces bodily manifestations almost
entirely and creates all its symptoms psychologically. Compulsion
neurosis and hysteria are those forms of neurotic disease by the study
of which psychoanalysis has been built up, and in whose treatment as
well the therapy celebrates its triumphs. Of these the compulsion
neurosis, which does not take that mysterious leap from the psychic to
the physical, has through psychoanalytic research become more intimately
comprehensible and transparent to us than hysteria, and we have come to
understand that it reveals far more vividly certain extreme
characteristics of the neuroses.
The chief manifestations of compulsion neurosis are these: the patient
is occupied by thoughts that in reality do not interest him, is moved by
impulses that appear alien to him, and is impelled to actions which, to
be sure, afford him no pleasure, but the performance of which he cannot
possibly resist. The thoughts may be absurd in themselves or thoroughly
indifferent to the individual, often they are absolutely childish and in
all cases they are the result of strained thinking, which exhausts the
patient, who surrenders himself to them most unwillingly. Against his
will he is forced to brood and speculate as though it were a matter of
life or death to him. The impulses, which the patient feels within
himself, may also give a childish or ridiculous impression, but for the
most part they bear the terrifying aspect of temptations to fearful
crimes, so that the patient not only denies them, but flees from them in
horror and protects himself from actual execution of his desires through
inhibitory renunciations and restrictions upon his personal liberty. As
a matter of fact he never, not a single time, carries any of these
impulses into effect; the result is always that his evasion and
precaution triumph. The patient really carries out only very harmless
trivial acts, so-called compulsive acts, for the most part repetitions
and ceremonious additions to the occupations of every-day life, through
which its necessary performances--going to bed, washing, dressing,
walking--become long-winded problems of almost insuperable difficulty.
The abnormal ideas, impulses and actions are in nowise equally potent in
individual forms and cases of compulsion neurosis; it is the rule,
rather, that one or the other of these manifestations is the dominating
factor and gives the name to the disease; that all these forms, however,
have a great deal in common is quite undeniable.
Surely this means violent suffering. I believe that the wildest
psychiatric phantasy could not have succeeded in deriving anything
comparable, and if one did not actually see it every day, one could
hardly bring oneself to believe it. Do not think, however, that you give
the patient any help when you coax him to divert himself, to put aside
these stupid ideas and to set himself to something useful in the place
of his whimsical occupations. This is just what he would like of his own
accord, for he possesses all his senses, shares your opinion of his
compulsion symptoms, in fact volunteers it quite readily. But he cannot
do otherwise; whatever activities actually are released under compulsion
neurosis are carried along by a driving energy, such as is probably
never met with in normal psychic life. He has only one remedy--to
transfer and change. In place of one stupid idea he can think of a
somewhat milder absurdity, he can proceed from one precaution and
prohibition to another, or carry through another ceremonial. He may
shift, but he cannot annul the compulsion. One of the chief
characteristics of the sickness is the instability of the symptoms; they
can be shifted very far from their original form. It is moreover
striking that the contrasts present in all psychological experience are
so very sharply drawn in this condition. In addition to the compulsion
of positive and negative content, an intellectual doubt makes itself
felt that gradually attacks the most ordinary and assured certainties.
All these things merge into steadily increasing uncertainty, lack of
energy, curtailment of personal liberty, despite the fact that the
patient suffering from compulsion neurosis is originally a most
energetic character, often of extraordinary obstinacy, as a rule
intellectually gifted above the average. For the most part he has
attained a desirable stage of ethical development, is overconscientious
and more than usually correct. You can imagine that it takes no
inconsiderable piece of work to find one's way through this maze of
contradictory characteristics and symptoms. Indeed, for the present our
only object is to understand and to interpret some symptoms of this
disease.
Perhaps in reference to our previous discussions, you would like to know
the position of present-day psychiatry to the problems of the compulsion
neurosis. This is covered in a very slim chapter. Psychiatry gives names
to the various forms of compulsion, but says nothing further concerning
them. Instead it emphasizes the fact that those who show these symptoms
are degenerates. That yields slight satisfaction, it is an ethical
judgment, a condemnation rather than an explanation. We are led to
suppose that it is in the unsound that all these peculiarities may be
found. Now we do believe that persons who develop such symptoms must
differ fundamentally from other people. But we would like to ask, are
they more "degenerate" than other nervous patients, those suffering, for
instance, from hysteria or other diseases of the mind? The
characterization is obviously too general. One may even doubt whether it
is at all justified, when one learns that such symptoms occur in
excellent men and women of especially great and universally recognized
ability. In general we glean very little intimate knowledge of the great
men who serve us as models. This is due both to their own discretion and
to the lying propensities of their biographers. Sometimes, however, a
man is a fanatic disciple of truth, such as Emile Zola, and then we hear
from him the strange compulsion habits from which he suffered all his
life.[38]
Psychiatry has resorted to the expedient of speaking of "superior
degenerates." Very well--but through psychoanalysis we have learned that
these peculiar compulsion symptoms may be permanently removed just like
any other disease of normal persons. I myself have frequently succeeded
in doing this.
I will give you two examples only of the analysis of compulsion
symptoms, one, an old observation, which cannot be replaced by anything
more complete, and one a recent study. I am limiting myself to such a
small number because in an account of this nature it is necessary to be
very explicit and to enter into every detail.
A lady about thirty years old suffered from the most severe compulsions.
I might indeed have helped her if caprice of fortune had not destroyed
my work--perhaps I will yet have occasion to tell you about it. In the
course of each day the patient often executed, among others, the
following strange compulsive act. She ran from her room into an
adjoining one, placed herself in a definite spot beside a table which
stood in the middle of the room, rang for her maid, gave her a trivial
errand to do, or dismissed her without more ado, and then ran back
again. This was certainly not a severe symptom of disease, but it still
deserved to arouse curiosity. Its explanation was found, absolutely
without any assistance on the part of the physician, in the very
simplest way, a way to which no one can take exception. I hardly know
how I alone could have guessed the meaning of this compulsive act, or
have found any suggestion toward its interpretation. As often as I had
asked the patient: "Why do you do this? Of what use is it?" she had
answered, "I don't know." But one day after I had succeeded in
surmounting a grave ethical doubt of hers she suddenly saw the light and
related the history of the compulsive act. More than ten years prior she
had married a man far older than herself, who had proved impotent on the
bridal night. Countless times during the night he had run from his room
to hers to repeat the attempt, but each time without success. In the
morning he said angrily: "It is enough to make one ashamed before the
maid who does the beds," and took a bottle of red ink that happened to
be in the room, and poured its contents on the sheet, but not on the
place where such a stain would have been justifiable. At first I did not
understand the connection between this reminiscence and the compulsive
act in question, for the only agreement I could find between them was in
the running from one room into another,--possibly also in the appearance
of the maid. Then the patient led me to the table in the second room and
let me discover a large spot on the cover. She explained also that she
placed herself at the table in such a way that the maid could not miss
seeing the stain. Now it was no longer possible to doubt the intimate
relation of the scene after her bridal night and her present compulsive
act, but there were still a number of things to be learned about it.
In the first place, it is obvious that the patient identifies herself
with her husband, she is acting his part in her imitation of his running
from one room into the other. We must then admit--if she holds to this
role--that she replaces the bed and sheet by table and cover. This may
seem arbitrary, but we have not studied dream symbolism in vain. In
dreams also a table which must be interpreted as a bed, is frequently
seen. "Bed and board" together represent married life, one may therefore
easily be used to represent the other.